Background

What is repetitive transcranial magnetic stimulation (rTMS)?

A coil held against the head generates short magnetic pulses that stimulate nerve cells in a small area of the cortex - as an outpatient, without surgery or anaesthesia.

Repetitive transcranial magnetic stimulation treatment at our Berlin practice

A look inside

Treatment at our practice

Mechanism

How does rTMS act on the brain?

The physical principle is well understood; the biological pathways are still being researched. Three levels interlock:

A magnetic field, not a current

A short, strong current pulse runs through the coil - none of it enters the head. What acts is the magnetic field it creates: it passes through scalp and skull unimpeded and stimulates the nerve cells in the target area. The field strength is roughly that of an MRI scanner.

Steering excitability

Whether an area is stimulated or dampened depends mainly on the pulse frequency: high-frequency stimulation (around 10 Hz) increases excitability, low-frequency stimulation (around 1 Hz) reduces it. In depression, the left dorsolateral prefrontal cortex is usually stimulated at high frequency - a region that imaging studies often find underactive.

Repetition and plasticity

A single pulse lasts only milliseconds. Only repetition across a treatment series - hence "repetitive" - leads to longer-lasting changes in signal transmission between nerve cells. Effects on neurotransmitters and on the coupling between distant brain areas have been described, among others.

Magnetic coil above a patient's head during treatment

Treatment course

How treatment works

From the first conversation to the end of the series - outpatient and without after-effects.

Step 1

First appointment and assessment

Dr Schwarz discusses your situation, your treatment so far and your goals. This includes questions about pre-existing conditions, medication and implants. The conversation is free of charge and without obligation.

Step 220-30 sessions

Treatment series

The first session takes longer: we determine the motor threshold and define the target area. With the theta burst protocol, a treatment session then takes only a few minutes, so several can be done on the same day and the series can be scheduled compactly.

Step 3

Joint review

At the end we discuss the course of treatment, the next steps and whether maintenance sessions make sense.

Evidence

What the research shows

Three key studies on rTMS for depression - each with its limitations.

The German National Care Guideline on unipolar depression (2022) recommends rTMS: it “should be offered for treatment-resistant depressive episodes” (recommendation 7-29, grade B). Other indications are treated as an individual treatment attempt.

View the guideline

2019n = 6750

Comparative Efficacy and Acceptability of Non-Surgical Brain Stimulation for the Acute Treatment of Major Depressive Episodes in Adults: Systematic Review and Network Meta-Analysis

Mutz, Vipulananthan, Carter et al. · BMJ

Zehn Verfahren waren der Scheinbehandlung bei der Ansprechrate überlegen - darunter mehrere rTMS-Varianten (hochfrequent, niederfrequent, bilateral) und die Theta-Burst-Stimulation

Context: Meta-Analyse über heterogene Studien mit unterschiedlichen Protokollen, Stimulationsorten und Patientenkollektiven. Für neuere Verfahren (etwa beschleunigte Protokolle) war die Datenbasis noch begrenzt, und Netzwerk-Meta-Analysen beruhen teils auf indirekten Vergleichen. Die Autoren betonen weiteren Forschungsbedarf.

View study

2018n = 414

Effectiveness of Theta Burst versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Depression (THREE-D): A Randomised Non-Inferiority Trial

Blumberger, Vila-Rodriguez, Thorpe et al. · The Lancet

HAMD-17 sank in beiden Gruppen praktisch identisch (23,5 -> 13,4 unter 10 Hz; 23,6 -> 13,4 unter iTBS) - iTBS war der 10-Hz-rTMS nicht unterlegen

Context: Nichtunterlegenheitsstudie ohne Sham-Arm - sie belegt die Gleichwertigkeit beider aktiver Protokolle, nicht die Überlegenheit gegenüber einer Scheinbehandlung (dafür stehen die sham-kontrollierten Studien). Offene Behandlung mit verblindeter Auswertung; untersucht wurde therapieresistente Depression.

View study

2012n = 307

Transcranial Magnetic Stimulation (TMS) for Major Depression: A Multisite, Naturalistic, Observational Study of Acute Treatment Outcomes in Clinical Practice

Carpenter, Janicak, Aaronson et al. · Depression and Anxiety

Ansprechrate (klinisch, CGI-S): 58,0%; Remission: 37,1%

Context: Naturalistische Beobachtung ohne Kontroll-/Sham-Gruppe - ein Placebo-Anteil lässt sich nicht herausrechnen, kein randomisiertes Design. Die Stärke liegt in der Übertragbarkeit auf die reale Versorgungspraxis, nicht im kausalen Wirksamkeitsnachweis (den liefern die RCTs).

View study

All studies at a glance

Costs

Costs and reimbursement

Private health insurers and civil-service assistance schemes usually reimburse rTMS fully or partly, depending on the policy; we provide the medical rationale. Statutory health insurers do not list the procedure in their benefits catalogue, which makes rTMS a self-pay service there: billing follows the German scale of medical fees (GOÄ) per session, coming to about 1,975 € for a series of 20 sessions. The introductory conversation is free of charge and without obligation.

Contact

Request our information brochure

Free of charge by email. We will get back to you without obligation.

Suitability is assessed by a doctor in each individual case. The treatments are self-pay services; private health insurers often reimburse them.